Biosurveillance Opportunities Prepared & Presented by Cynthia - - PowerPoint PPT Presentation

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Biosurveillance Opportunities

Prepared & Presented by Cynthia Harry, MSPH, Epidemiologist, Oklahoma City-County Health Department (OCCHD) & Dean Lampman, MBA, Regional Surveillance Coordinator, Southwest Center for Advanced Public Health Practice (APC)

73rd Annual Oklahoma Public Health Association Conference April 5-6, 2012 Embassy Suites, Norman, OK

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Session Agenda

Biosurveillance Opportunities

• Surveillance Systems Overview
• Advanced Practice Center (APC) Products
• TCPH Child Health Surveillance Program
• OCCHD School & Health Surveillance Program
• OCCHD QI Evaluation of APC Product
• Our Meaningful Use Opportunity
• Conclusions / Recommendations
• Questions / Answers

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Ongoing systematic collection, analysis, and interpretation of health data in the process of describing and monitoring a health event or events

Surveillance Defined

www.cdc.gov/ncphi/disss/nndss/syndromic.htm

Biosurveillance Opportunities

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Regular collection, analysis, and interpretation of real-time or near-real-time indicators of disease and other outbreaks by public health

http://faculty.nps.edu/rdfricke/docs/SyndromicSurveillanc e.pdf

Syndromic Surveillance Defined

Biosurveillance Opportunities

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• Health data preceding diagnosis

–Best if it’s near real-time

• Facilitates public health response:

–Signals if case/ outbreak is significant –Allows ongoing tracking of outbreak –Supports collaboration with providers

Syndromic Surveillance Benefits

Biosurveillance Opportunities

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What’s Under the Hood

In systems such as ESSENCE ...

• Algorithms used to classify data

– Free text and/or ICD9 codes – Cast in syndromes and medical subgroups

• Analyzes all categories for anomalies

– Temporal or spatial – Check vs. expected values

• Automated reports, alerts for anomalies

Biosurveillance Opportunities

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How Partners Share Data

• Data use agreement has ‘HIPAA’ coverage

for data elements to be shared

• Contract amendment if elements change
• Assess network connections and

transfer methods: typically VPN and HL7, but can vary

• Identify and link to interfaces
• Send test files, work out mapping
• Project time varies, but can be

accurately estimated; isn’t “huge.”

“It’s not rocket science!”

Biosurveillance Opportunities

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Child health surveillance

Helps:

• Monitor flu activity
• Assess impact of disease
• Detect pandemic or epidemic
• Slow flu with > awareness
• Allocate resources

Biosurveillance Opportunities

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Why focus on youth?

• Accelerate flu transmission
• Biologically more susceptible
• One of 3 high-risk groups
• Impact rest of household
• Flu-friendly environment

Biosurveillance Opportunities

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ILI data’s importance

• Aggregated data can mask trends
• Total absenteeism is insufficient
• Reveals reasons for absenteeism
• More precisely characterizes flu
• Provides actionable information

ILI has 2 key symptoms: 1) Temperature >100° & 2) Cough / sore throat w/ no other known cause. Also may involve malaise and muscle aches, runny nose, chills or headache.

Biosurveillance Opportunities

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• 1. Data types [ < or = meaningful use]
• 2. Technical standards for connection
• 3. Data quality, accessibility
• 4. Response protocols
• 5. Cost-effectiveness
• 6. Scalability, longevity
• 7. Community of practice

What public health must address

Biosurveillance Opportunities

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Session Agenda

Biosurveillance Opportunities

• Surveillance Systems Overview
• Advanced Practice Center (APC) Products
• TCPH Child Health Surveillance Program
• OCCHD School & Health Surveillance Program
• OCCHD QI Evaluation of APC Product
• Our Meaningful Use Opportunity
• Conclusions / Recommendations
• Questions / Answers

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APC Program and Network

• Launched in 1999 by NACCHO, CDC
• Package work of a few exemplary LHDs
• Build, share innovative, practical tools
• Created by LHDs for LHDs
• APC network completed 100+ products
• All free emergency preparedness tools

Biosurveillance Opportunities

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APC – PHEP Alignment Project

• Conducted in summer 2011
• Reviewed 94 APC products (now 109)
• Self-assessment by the 8 APCs
• APCs: LHDs, PHEP: local & state PH
• APC products align:

– To all 15 of the PHEP capabilities – With 100% of functions for each capability – With 90% of capability components

Biosurveillance Opportunities

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Tarrant County APC

• Formed Fall ’03 by NACCHO, CDC
• Regional focus – DSHS Region 2/ 3
• 16 products, mostly in 3 areas:

– Disease detection, investigation – Emergency preparedness, assessment – Workforce training, development

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Biosurveillance Resource CD

• Comprehensive
• Lessons learned
• Case studies
• Flexible
• Many resources
• Peer reviewed

Biosurveillance Opportunities

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School Health Surveillance Kit

• CIDRAP Promising & NACCHO Model Practice
• Used in novel ways (including childcare data)
• 4 case studies (OH, KS & TX)

Biosurveillance Opportunities

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Session Agenda

Biosurveillance Opportunities

• Surveillance Systems Overview
• Advanced Practice Center (APC) Products
• TCPH Child Health Surveillance Program
• OCCHD School & Health Surveillance Program
• OCCHD QI Evaluation of APC Product
• Our Meaningful Use Opportunity
• Conclusions / Recommendations
• Questions / Answers

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School surveillance goals

• 1. Apply biosurveillance to PH practice
• 2. Respond to surveillance clues
• 3. Target flu shots, specimen sampling
• 4. Campus data, not just district data
• 5. Daily rather than weekly data
• 6. No vacuum cleaner approach

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TCPH’s key partners

• Dr. Tabatha Offutt-Powell
• Tarrant County APC
• Texas DSHS
• Ingen Systems
• School nurses

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System elements

• Electronic reporting via Web portal

– Student absences, flu-related absences – Nurse perpection of ILI – School closure & reasons – Faculty absences and ILI – Comment box and feedback support

• Maps, resources and data for nurses

– Appropriate for a flu prevention campaign

Biosurveillance Opportunities

SQL DB

• n DNN

SHSS data flow

ESSENCE DB @ TCPH

Royalty free ESSENCE application Data entry form on

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source portal (DNN) Form takes < 5 min These fields optional CDC definition of ILI given

Secure log in with no registration link to ease account management and avoid duplication

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Role-based security lets you serve up unique content to different groups.

Landing page offers simple menu, data form, action items, news, and a wealth of resources

ESSENCE maps of flu and ILI patterns by region. You can click on each image to see a larger view. Maps show the county and quadrants of the county.

Next / previous =

• ther images.

Close = back to main maps page. Sample ILI map of Tarrant County using ESSENCE hospital ED data

Users can access flu prevention resources. More can be added easily. RSS is supported. Users can view and edit their reports using a drop-down box for each school. Charts & cross tabs allow limited in-system data analysis.

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Biosurveillance Opportunities We use a custom blog module, Nuke Press, to post news. User comments capability is inactive.

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Selected evaluation findings

• Simple design, minimal data worked
• Collected in < 30 min., sent in < 5 min.
• Difficulty with “reason for absence”
• Participation sufficient and stable
• Statistically valid, representative data
• More work needed with childcare centers
• Complements other data sources

Biosurveillance Opportunities

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Session Agenda

Biosurveillance Opportunities

• Surveillance Systems Overview
• Advanced Practice Center (APC) Products
• TCPH Child Health Surveillance Program
• OCCHD School & Health Surveillance Program
• OCCHD QI Evaluation of APC Product
• Our Meaningful Use Opportunity
• Conclusions / Recommendations
• Questions / Answers

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• Build community relationships w/ schools
• Recruit schools across county for reporting
• Construct Website for daily reporting
• Send data to syndromic surveillance system

OCCHD’s Initial Project Goals

Biosurveillance Opportunities

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• Facilitate communication between

many community partners & OCCHD

• Inform community on disease trends
• Disease control, prevention resources
• Build other community relationships
• Fill in a spectrum of useful data:

– OTC, EMS, urgent care centers, EDs, schools, dental, veterinarians, water, poison control

Transcending School Health

Biosurveillance Opportunities

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Session Agenda

Biosurveillance Opportunities

• Surveillance Systems Overview
• Advanced Practice Center (APC) Products
• TCPH Child Health Surveillance Program
• OCCHD School & Health Surveillance Program
• OCCHD QI Evaluation of APC Product
• Our Meaningful Use Opportunity
• Conclusions / Recommendations
• Questions / Answers

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• Biosurveillance Toolkit (4 APC Products)
• Helps LHDs explore, set up biosurveillance systems
• Set evaluation objectives
• Developed chain of success document
• Worked with independent QI consultant
• Submitted evaluation

OCCHD’s Product QI Evaluation

Biosurveillance Opportunities

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• Successfully implement ESSENCE at OCCHD

– Survey to evaluate the ease of use

• Hospitals running real-time feed every 2 hours

– Develop useful reports for hospitals – Determine their wants and needs

• Explore School Health Surveillance

– Assess barriers to participation, daily reporting – Conduct practice exercise using historical data – Compare to other systems (CDC & UNT HSC)

QI Evaluation Objectives

Biosurveillance Opportunities

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• Compare TCPH protocols to OCCHD’s

– Consider strengths. weaknesses – Determine which parts OCCHD might adopt

• Train all system users on ESSENCE

– Use the Tarrant County toolkit – Survey for ease of use & enhancements

More QI Evaluation Objectives

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• APC not allowed to offer much help

–Delayed ESSENCE implementation –Needed funding to get help from JHU APL –Changed focus of the QI evaluation

• Could only evaluate toolkit for using ESSENCE; could

not compare ESSENCE to current surveillance system

–Ripple effect: delayed school health project

Evaluation Delays & Their Impact

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• Installed new syndromic surveillance system
• Strengthened relationships with partners
• Gained new data from hospitals, schools
• Built partnerships with other LHDs
• Developed health surveillance portal
• Added a training tool for new staff

Evaluation Highlights

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• Changes to toolkit material
• IT support issues
• Outside contracts
• Maintenance of data sharing agreements
• Maintenance of community relationships
• Reaching out to other health departments

Some lessons learned

Biosurveillance Opportunities

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Session Agenda

Biosurveillance Opportunities

• Surveillance Systems Overview
• Advanced Practice Center (APC) Products
• TCPH Child Health Surveillance Program
• OCCHD School & Health Surveillance Program
• OCCHD QI Evaluation of APC Product
• Our Meaningful Use Opportunity
• Conclusions / Recommendations
• Questions / Answers

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Meaningful Use Overview

• HITECH* Act (’09): $17B in incentives**

* Health Info. Tech. for Economic & Clinical Health ** Run by Centers for Medicare & Medicaid Svcs

Biosurveillance Opportunities

• Eligible Professional (EP) / hospitals must:

– Use certified electronic health record (EHR) – Meet criteria in each stage

• Cumulative (5 yr) incentive:

– $44,000 under Medicare – $63,750 under Medicaid

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Stage 1 Criteria Focus

Electronic capture of health information

• In a structured format w/ an EHR
• To track key clinical conditions
• Ease disease, medication management

Communicate info for care coordination

• Report clinical quality measures
• Report public health information
• Engage patients and families

Biosurveillance Opportunities

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Stage 1 Public Health Criteria

• Opt. 1: Submit data to immunization registry
• Opt. 2: Submit syndromic surveillance data
• Opt. 3: Submit electronic lab data

Biosurveillance Opportunities

Perform at least 1 test to show the capability to submit data, if PH can take it.

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Meaningful Use Data Elements*

* ISDS Recommended ED Syndromic Surveillance Data Elements; ISDS Meaningful Use Workgroup, October 2011

Biosurveillance Opportunities

• 1. Facility identifier
• 2. Facility / visit type
• 3. Report date / time
• 4. Unique patient identifier
• 5. Unique visiting ID
• 6. Diagnosis type
• 7. Age
• 8. Age units
• 9. Gender
• 10. Zip Code
• 11. County
• 12. Race
• 13. Ethnicity
• 14. Visit date / time
• 15. Chief Complaint / visit reason
• 16. Diagnosis / external cause of injury code
• 17. Discharge disposition

NOTE: Data elements 6, 12, 13, 16 & 17 add value to what’s in most current syndromic surveillance systems. Stage 2 data goes MUCH further in robustness of clinical data.

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Powerful Impact for Public Health

“Meaningful use is a powerful opportunity for public health. With a phased approach, by 2015, public health will have more and stronger partners working to improve population health. There is increased opportunity to reduce disparities, control chronic diseases and build a health-promoting healthcare system.”

www.cdc.gov/ehrmeaningfuluse/introduction.html Biosurveillance Opportunities

Richer clinical data also means we move from just knowing something’s occurring to getting stronger, faster clues about what is happening.

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Session Agenda

Biosurveillance Opportunities

• Surveillance Systems Overview
• Advanced Practice Center (APC) Products
• TCPH Child Health Surveillance Program
• OCCHD School & Health Surveillance Program
• OCCHD QI Evaluation of APC Product
• Our Meaningful Use Opportunity
• Conclusions / Recommendations
• Questions / Answers

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You can and should convey these messages:

• Interested in working with the provider

–They are important to achieving holistic view

• Ability to address PH meaningful use goals

–Be specific about which ones (any or all)

• You’ll provide needed technical information

–Message transmission and standards

• You are credible & trustworthy

–Show it by asking good questions

Show Interest, Intent, Ability

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Convey Additional Benefits

Benefits not limited to MU incentives:

• ESSENCE’s hospital view helps hospitals
• Chance to replace paper with e-processes
• Access to other reports you prepare
• Better coordination with public health
• Regional situational awareness w/ all players
• PR, promotional support can be provided

Biosurveillance Opportunities

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Use Appropriate Tools, Technologies

• Tarrant County APC is an open source advocate:

– No licensing fee or vendor dependence – Support of a developer community

• Some tools, technologies we recommend:

– ESSENCE and BioSense 2.0 – Mirth as an interface engine – DotNetNuke as a Web portal CMS

Biosurveillance Opportunities

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Secure resources, time

• Technical work isn’t trivial. Options:

– Build your system with your own staff – Build your system with outsourced staff – Purchase a system; maintain internally or outsource it – App. Service Provider (ASP) model (total outsourcing) – Hybrid approaches to these / cloud-based model

• Time requirement isn’t trivial:

– Amount per connect varies from a few days to months – Commitment and resources of providers varies

• Program cost not large, but must be considered

Biosurveillance Opportunities

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What questions can we answer?

Dean Lampman, MBA, Regional Surveillance Coordinator, APC dflampman@tarrantcounty.com (817) 321-5372 Cynthia Harry, MSPH, Epidemiologist, OCCHD Cynthia_harry@occhd.org (405) 425-4495 Biosurveillance Opportunities More information & downloads: www.ntexasapc.net http://apc.naccho.org www.occhd.org

Thank you for your attendance and attention!